4. Cervical Orthosis-1

Cervical Orthosis
OVERVIEW
 Introduction
 Function of cervical orthoses
 Classification
 Flexion/Extension Control Devices
 Flexion/Extension/Lateral Flexion/Rotation Control Devices
 Normal Motion Vs Restriction of Neck Movement with Orthosis
INTRODUCTION
 Cervical orthosis includes devices used in treatment of disorders around the
region of neck and skull
 Immobilizing cervical spine is difficult because:
 Most mobile part in spine
 Has small body surface
 Limited pressure tolerant areas like chin, occiput
 Different types of predominant movement at different levels
FUNCTION OF CERVICAL ORTHOSIS (CO)
 Positions the head in position
 Limits movement in flexion, extension, rotation and lateral rotation
 Unload the cervical spine by weight bearing part of skull.

CLASSIFICATION
 Cervical orthosis can be classified as:
 Cervical collars
 Poster appliances
 Cervicothoracic orthosis
 Halo devices
FLEXION/EXTENSION CONTROL
DEVICES
 Soft cervical collar
 Semirigid cervical collar with chin—Occiput support
 Philadelphia orthosis
 SOMI brace (Sterno Occiputo Mandibular Immobilization Brace)
FLEXION/EXTENSION/LATERAL
FLEXION/ROTATION CONTROL DEVICES
 Poster orthosis
 Halo brace
 Minerva body jacket
CERVICAL COLLARS
 Soft cervical collar
 Construction
 It is made of foam and rubber covered by a stockinet.
 Advantages
 Low cost
 Easy to fabricate
 Tolerated by patient
 Provides warmth and psychological comfort
 Disadvantage
 Does not restrict cervical motion in any plane and serves only as a remainder to
hold neck and avoid excessive movement.
CONTD…
 Semi-rigid Cervical Collar
 Construction
 It is made of rigid polypropylene. Height of the orthosis can be changed by
adjusting the two parts of collar.
 Advantages:
 Easy to apply and remove
 Some restriction of flexion and extension
 Chin and occipital extension can be added.
 Disadvantage:
 Does not restrict lateral bending and rotation.
 Can press on clavicle and give discomfort.
PHILADELPHIA ORTHOSIS
 Construction
 Philadelphia orthosis is made of plastozote reinforced with anterior and posterior
struts. It has molded mandibular and occipital support. Anteriorly and posteriorly it
extends to upper thorax.
 Advantages
 Restricts flexion extension due to chin and occiput support and thoracic
extension.
 Disadvantages
 Ineffective in controlling rotation and lateral bending
 Pressure over clavicle.
SOMI BRACE
 Construction
 It is a modified poster appliance
 It consists of:
 Sternal plate
 One anterior strip which hold chin support
 Two rigid metal rods from anterior to posterior to occiput support
 Advantages:
 There is no posterior post. So it can be used with patient lying supine.
 Light weight donning and doffing
POSTER APPLIANCES
 It has anterior section consisting of sternal support, one or two uprights and
chin support. Posterior section consist of thoracic plate, one or two uprights
and an occipital support
 It limits flexion, extension, rotation and lateral flexion. It also unloads the
cervical spine by chin and occiput support
CONTD…
 Two varieties are
 Four poster orthosis (Thomas collar)
 Two poster orthosis (Peter Cervicothoracic orthosis) which provides less
lateral stability
YALE CERVICOTHORACIC ORTHOSIS
 Yale cervicothoracic orthosis is a modified philadelphia collar with plastozole
reinforced with struts
 It extends down to mid thorax anteriorly and posteriorly.
 Occipital support extends higher on skull.
 With extended area of support stability is increased
HALO BRACE
 Halo devices are used for treating cervical fractures and dislocation. It consist
of:
 Rigid metal or graphite ring attached to skull by four fixation pins
 Four posters which are attached to ring proximally-two anteriorly, two posteriorly
and distally to polypropylene vest
 Polyethylene vest: The vest may be of:
 Half vest—Level of nipples for upper cervical injuries
 Short extended vest up to the level of 12th rib
 Full vest—Level of iliac crest for lower cervical injuries.
MINERVA BODY JACKET
 This is an orthosis made of Plaster of Paris or Thermo Plastic
 It consist of:
 Forehead adaptation with occipital support
 Chin support
 Body jacket that extends up to the level of twelfth rib or umbilicus
 Advantages
 Light weight (plastic)
 No invasive pins like halo device
 It limits flexion, extension, rotation and lateral rotation like halo brace
CONTD…
 Halo device and Minerva body jacket are the choice in ambulant
management of unstable cervical spine
NORMAL MOTION VS RESTRICTION OF
NECK MOVEMENT WITH ORTHOSIS
No Orthosis Name Flexion/Extension Lateral bending Rotation
1. Normal 100% 100% 100%
2. Soft collar 25% restriction 8% restriction 16% restriction
3. Philadelphia 71% restriction 33% restriction 56% restriction
4. SOMI 72% restriction 34% restriction 64% restriction
5. Four poster 80% restriction 54% restriction 82% restriction
6. Halo 89% restriction 92% restriction 98% restriction
7. Minerva body 77% restriction 76% restriction 100% restriction
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Cervical Orthosis

 Positions the head in position

 Limits movement in flexion, extension, rotation and lateral rotation

 Unload the cervical spine by weight bearing part of skull.

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